GESTIÓN EN SALUD PÚBLICA: Power to the patient: New UK consent regulations

domingo, 30 de octubre de 2016

Power to the patient: New UK consent regulations

Power to the patient: New UK consent regulations

Bioedge

Power to the patient: new UK consent regulations

by Xavier Symons | 29 Oct 2016 |

The Royal College of Surgeons (RCS) has warned its members of a dramatic increase in the number of litigation pay-outs made if changes are not made to consent processes before surgery.

The RCS published new guidelines for surgeons earlier this week, instructing doctors to ensure that patients are aware of any and all risks that could possibly be considered “significant”. The guidelines instruct doctors to make no assumptions about the information a patient might want or need; the patient should be the one to decide which risks are material.

According to the NHS Litigation Authority (NHSLA), which handles medical negligence claims on behalf of hospitals, NHS trusts in England paid out more than £1.4 billion in claims during 2015/2016.

It had been standard practice for doctors to decide which risks they would communicate to patients, but a recent court ruling has forced the RCS to change its guidelines.

In the 2015 Supreme Court case Montgomery vs Lanarkshire Health Board the notion of informed consent was clarified, and the seven judges presiding over the case – an unusually large number because of the significance of the case – agreed that doctors must tell patients not only what they think they need to know but also the risks that might matter to the patient.

The case involved a woman, Nadine Montgomery, whose son has cerebral palsy. Montgomery was awarded £5.25m compensation because doctors did not explain the very small risk associated with a normal birth in her case – she is small and a type 1 diabetic.

“Hospitals and medical staff are leaving themselves very vulnerable to expensive litigation and increased pay-outs by being slow to change the way the consent process happens”, said Mr Leslie Hamilton, a Royal College of Surgeons Council Member.

Yet some doctors are concerned that the changes prevent doctors from offering valuable, expert advice. “This new guidance raises a number of questions”, GP Ann Robinson wrote in The Guardian. “Is it “paternalistic” for a doctor to offer an opinion? And what if you genuinely want to know what the doctor would do if faced with the same choices?”

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It appears that Canada has experienced a visitation from an “angel of mercy”, a media euphemism for a medical serial killer. Arrested this week, Elizabeth Wettlaufer allegedly killed eight patients in Ontario nursing homes since 2007. The Canadian media is describing her as one of Canada’s worst serial killers.

She faces stiff competition in other countries. In Italy, Daniela Poggiali, a nurse, was sentenced earlier this year over 13 deaths. In the US, Charles Cullen, a nurse. was sentenced in 2006 over the deaths of about 40 patients. In Germany Stephan Letter killed at least 29 patients in 2003 and 2004. And then there is Dr Harold Shipman, the quiet English doctor who killed 250 patients.

These horrors never seem to be mentioned when the legalization of euthanasia is being debated, but they should be. The existence of these mad “angels of mercy” demonstrates that some healthcare professionals feel compelled to kill the defenceless people entrusted to their care.

Legalisation creates a class of people who do the same thing but without the secrecy. In Belgium and the Netherlands, the bulk of the euthanasia business seems to be carried out by a handful of doctors. Some of them have killed scores of patients. What does that do to them? Why do they volunteer? Will there be more “angels of mercy” in jurisdictions where euthanasia is legal? These are all questions that need to be asked and answered.